Provider Demographics
NPI:1558066357
Name:SWEET GRACE MIDWIFERY
Entity Type:Organization
Organization Name:SWEET GRACE MIDWIFERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:904-570-5792
Mailing Address - Street 1:332 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-4614
Mailing Address - Country:US
Mailing Address - Phone:904-570-5792
Mailing Address - Fax:
Practice Address - Street 1:332 E 6TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-4614
Practice Address - Country:US
Practice Address - Phone:904-570-5792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty